Digital Morphology: What Advances Mean for Modern Laboratories, and Why Continued Innovation Is Imperative
2024-07-11
Advances in technology mean that moving from microscopes to digital alternatives can now be achieved without sacrificing image quality. But this isn’t about the technology. Professor Gina Zini, reflects on the key benefits of digital developments, including better quality screening, saved time for busy morphologists, better clinical collaboration, improved training, and sharing expertise with developing countries.
When I started my career as a haematologist, examining a blood smear meant looking through a microscope. This was the standard throughout the world. Advances in technology, especially digital tools, have transformed laboratory workflows. These innovations are expanding in fields like hematology, automating tasks and enhancing efficiency, quality, and collaboration - critical in an environment facing shortages of skilled professionals
What have laboratories been achieving in digital morphology?
Digital morphology analysers have been adopted in many parts of the world as one means to improve efficiency in the laboratory, as well as the quality of reporting in screening programmes. They automate the analysis of blood smears in large quantities to identify abnormalities.
However, human expertise remains critical. Hematologists play a vital role in validating flagged cases, ensuring accuracy and reliability in screening programs.
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Modern digital morphology analysers have allowed laboratory professionals to view, validate and report from images on-screen, enabling them to more easily find cells and areas of concern than if they were looking through a microscope. Recalling images on the screen, compared to searching for cells on a slide under a microscope, significantly reduces the time and effort required for busy laboratory teams.
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Digital cellular images have facilitated intra- and sometimes inter-laboratory consensus and harmonization. Their accessibility and searchability allow teams, both onsite and remote, to easily share images and seek expert opinions. This enables colleagues, even those working from home, to collaborate on cases.
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Digital technologies have revolutionized the long-term storage of blood smears, which are often the primary or sole evidence for diagnoses like myelodysplastic syndrome, leukemia, lymphoma, or hemolytic anemia. Digital morphology images provide a more efficient and reliable method for preserving this critical information.
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And for some abnormal parameters provided by the automated analysers, such as red blood cell abnormal parameters, accuracy can be higher and less subjective than grading using microscopy. This can help staff to deliver important reports after conducting only a rapid qualitative assessment of the smear.
In short, digital morphology delivers significant advantages in laboratories seeking to improve turnaround times, quality and cost-efficiency, helping to alleviate the fatigue and workload challenges associated with optical morphology, and improving repeatability and management of cell images.
Why continued innovation is urgent and imperative, and where it is already happening?
The need for highly capable digital tools has now intensified. They are no longer just supporting efficient laboratory operations, but have become an urgent necessity for screening services under pressure.
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There is a critical shortage of experts in haematology and morphological analysis, who continue to manage an ever-increasing workload to support preventative healthcare. The situation now requires even better technologies to augment capacity. Digital morphology analysers are an important example of technology that has evolved to support this, and where innovation continues.
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Historically, though helpful, older devices have presented some limitations. Many of these devices have worked by rebuilding an image rather than displaying a true image of the smear, leading to differences in appearance compared to optical microscopy. This required additional training for laboratory teams to interpret images and identify areas of concern, ensuring consistent and effective reporting.
This is now changing, with new digital technologies able to reproduce precisely what is seen under a microscope.
This was proven to be the case in a performance analysis I recently contributed to around the MC-80 automated digital cell morphology analyser, launched by Mindray. Blood samples examined in the analysis demonstrated excellent reproducibility of cell images, which were a perfect match to those seen under a microscope.
I knew nothing of the cases prior to the study, but could immediately check and validate images on the screen. And this is made possible by the fact that for each sample evaluated, within the time of a click of the mouse, two hundred pre-classified images of nucleated cells appear on the screen with morphological details identical to those observed under an optical microscope.
This eliminates the time-consuming steps of locating the slide, positioning it on the microscope table, searching for the observation area, and adjusting focus with different objectives, including the use of oil immersion. Instead, the focus shifts entirely to observing the cells, confirming their pre-classification, or moving them to a different subclass when necessary. The system automatically regenerates the percentages of the differential after each movement.
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For a series of pathological samples, I averaged one to two minutes per sample for screen validation, compared to six to eight minutes per sample using an optical microscope, both evaluating at least 200 nucleated elements. This ability to create images indistinguishable from microscopy is state-of-the-art. The efficiency gains and support for better quality reporting are clear benefits, particularly in the context of limited resources.
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But it also opens up new possibilities around training and collaboration. Digital morphology can in general reduce the time it takes to train a good morphologist. But it is also worth bearing in mind that despite growing adoption, only around 37% of the world uses digital morphology. Many developing countries, for example, still rely on microscopy as their primary tool.
